Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic vulvar pruritus, soreness, and dyspareunia. Reports progressive thinning of vulvar skin, occasional fissuring, and dysuria. Denies history of infectious vaginitis or contact dermatitis. Symptoms exacerbated by friction and moisture.
Clinical Examination Findings
Vulvar examination reveals porcelain-white, atrophic plaques with areas of lichenification and excoriation. Loss of normal architectural landmarks noted, including resorption of the clitoral hood and narrowing of the introitus. No suspicious ulcerations or indurated masses identified. Perianal skin involvement noted (figure-of-eight distribution).
Treatment Protocol
Initiate high-potency topical corticosteroid therapy (e.g., Clobetasol propionate 0.05% ointment). Apply a pea-sized amount to affected areas once daily for 4 weeks, then taper frequency as symptoms improve. Emollient use recommended for barrier protection. Schedule follow-up in 6-8 weeks to assess response and monitor for secondary infection or atrophy.